Method Article

Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation

DOI:

10.3791/65954

⸱

July 5th, 2024

 ,  ,  ,  ,  , 
1Hospital of Chengdu University of Traditional Chinese Medicine, 2Traditional Chinese Medicine Department, Zigong First People's Hospital

In This Article

Summary

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Electroacupuncture combined with Chinese medicine ironing therapy can effectively improve patients' constipation symptoms and their quality of life. Here, we present a protocol to describe the treatment process of electroacupuncture combined with Chinese medicine ironing therapy for functional constipation.

Abstract

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Functional constipation (FC) is a dysfunctional gastrointestinal disease with the main clinical manifestations of complex bowel movements, incomplete bowel movements, reduced frequency of bowel movements, and dry and hard stools, which seriously affect patients' quality of life and psychology. Electroacupuncture improves constipation by performing acupuncture on specific points in the body to accelerate intestinal peristalsis. Chinese medicine ironing therapy (CMIT) can warm up the meridians, accelerate local blood circulation, promote gastrointestinal dynamics, and accelerate gastric emptying. This study elaborated on the method and steps of electroacupuncture combined with CMIT for functional constipation, including patient selection, material preparation, operation procedure, postoperative care, and precautions. The therapeutic effect of the method was also evaluated. The results of the study showed that after 4 weeks of treatment, compared with Western medicine alone, electroacupuncture combined with CMIT can improve the frequency of FC patients' voluntary bowel movements, constipation, and quality of life. There were no obvious adverse reactions.

Introduction

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

Functional constipation (FC)1is a chronic digestive disease that seriously affects patients' quality of life, mainly manifested by complex bowel movements, low frequency of bowel movements, hard or lumpy stools, and strained bowel movements2. FC significantly impacts the life and psychology of patients3 and is an essential factor in inducing severe diseases such as abdominal pain4, sleep disorders5, colon cancer6, and cardiovascular diseases7. Studies show that about 10%-15% of the global population is affected by FC8. FC is chronic and poorly treated, with nearly 50% of patients not fully satisfied with conventional treatment9, as a substantial public health problem that imposes a significant financial burden on patients10,11. Therapeutic measures for FC include general treatment (increased fluid intake, dietary fiber supplementation12,13, and exercise14) and pharmacological treatment (volumetric laxatives15, osmotic laxatives16, stimulant laxatives17, 5-hydroxytryptamine 4 receptor agonist18, and probiotics19,20,21). However, most drugs have adverse effects such as drug dependence, diarrhea, bloating, flatulence, intestinal cramps, and esophageal obstruction. Therefore, the search for an effective treatment for FC with few side effects has attracted the attention of clinicians.

Acupuncture is a form of treatment that originated in ancient China and is often used to treat various digestive disorders. Based on acupuncture, electroacupuncture applies mild and continuous electrical stimulation to strengthen needle feeling and improve clinical efficacy. Electroacupuncture improved weekly complete spontaneous bowel movements (CSBMs)22 and raised the Bristol Stool Form Scale (BSFS) score23. The mechanism may be related to promoting intestinal motility24 and increasing 5-hydroxytryptamine and tryptophan hydroxylase in the colon25. In general, electroacupuncture can effectively improve the clinical symptoms of FC patients26 and enhance the quality of life and treatment satisfaction of patients23,27.

Chinese medicine ironing therapy (CMIT) means heating a Chinese herbal medicine bag (called a reyan bag) and moving it back or rotating it at specific points. CMIT reduces nociceptive nerve excitability, improves blood circulation, promotes intestinal motility, and improves constipation through the physical effects of medicine and temperature28. Foeniculum vulgare Mill, commonly called fennel, has been used in CMIT mainly to bring into play its ability to promote Qi, warm the meridians, regulate the elevation of the spleen and stomach to eliminate stagnation, and pass stools29.

This study combined acupuncture with CMIT and acted on the gastrointestinal acupuncture points of FC patients to improve their constipation symptoms, providing a new and effective method for treating FC patients.

Protocol

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

The Institutional Review Committee of Zigong First People's Hospital reviewed and approved the clinical program. The treatment process, treatment principles, and adverse reactions were explained to the patients in detail in this study, and the patients were carried out after signing the informed consent form.

1. Patient assessment

  1. Inclusion criteria:
    1. Include patients who meet the Rome IV diagnostic criteria for functional constipation30.
    2. Include patients aged between 21 and 69 years old, regardless of gender.
    3. Before treatment (>14 days), ensure no medication was used to treat constipation (except for emergencies).
    4. Include patients who are not involved in other ongoing clinical studies.
    5. Include patients with no organic bowel disease confirmed by e-colonoscopy.
    6. Include patients who volunteered to join the study and signed informed consent.
  2. Exclusion criteria
    1. Exclude patients with other endocrine, metabolic, neurological, or postoperative diseases or medication-induced constipation.
    2. Exclude patients with irritable bowel syndrome, inflammatory bowel disease, or other structural bowel disease.
    3. Exclude patients with mental illness, cognitive dysfunction, or aphasia.
    4. Exclude patients who received acupuncture and CMIT within the past 4 weeks.
    5. Exclude patients with cardiac pacemakers.
  3. Intervention measures
    1. Divide patients into four groups using a random comparison table method.
      NOTE: The groups involved in this study are the control group, experimental group A (electroacupuncture group), experimental group B (CMIT group), and group C (electroacupuncture + CMIT group). The control group was given standardized treatment guided by Management of Functional Constipation in Children and Adults31 and the Consensus Opinion on Integrated Chinese and Western Medicine Treatment of Functional Constipation (2017)32.
    2. Ensure that all patients increased their water (2000 mL of water daily) and dietary fiber intake (30 g), developed good bowel habits (once a day), and performed regular exercises(three times a week for 30 min), such as bicycling and walking.
    3. Give the patients in the control group lactulose oral solution thrice daily, 15 mL each time, before meals for 4 weeks33.
    4. Treat the patients in Experimental Group A with electroacupuncture for 30 min five times in 1 week for 4 weeks based on the control group.
    5. Treat the patients in Experimental Group B with CMIT for 20 min daily for 4 weeks based on the control group.
    6. Treat the patients in Experimental Group C with electroacupuncture (30 min five times a week) and CMIT (20 min daily ) for 4 weeks based on the control group.
    7. After 4 weeks, assess the treatment effects of the two groups by weekly complete spontaneous bowel movements (CSBMs)34, the Cleveland constipation scoring system (CSS)35, and the patient assessment of constipation quality of life scale (PAC-QOL)36.

2. Material preparation

  1. Prepare the electroacupuncture equipment (Figure 1).
  2. Prepare the disposable sterile cloth bag, fennel seeds, and disposable sterile gloves required for Chinese medicine ironing therapy (Figure 2).

3. Treatment process

  1. Electroacupuncture treatment
    1. Body posture: Let the patient lie on the treatment bed, relax, and be comfortable.
    2. Locate and select acupoints:
      1. Locate Quchi (LI11) at the middle of the line between the lateral end of the elbow stripe and the humerus's external epicondyle37(Figure 3).
      2. Locate Shangjuxu (ST37) point at the anterolateral side of the lower leg, 6 cun (12 cm38) below the Dubi, with one cross finger (middle finger) from the front edge of the tibia37 (Figure 4).
        ​NOTE: Select points according to the study of meridian and acupoint39. Cun is a special measurement unit in TCM. It is the distance between the distal interphalangeal joint and the proximal interphalangeal joint of the index finger. Based on the literature, 1 cun is approximately 2.0-2.2 cm38,40.
    3. Use 75% alcohol to disinfect the operator's hands and the affected skin to prevent infection.
      NOTE: Electroacupuncture should avoid skin damage, nodules, and scarring; keep warm, and stay emotionally relaxed.
    4. Insert the needle vertically into bilateral Quchi (LI11) and Shangjuxu (ST37) points of the patient 1 cun (2 cm38) through lifting, inserting, twisting, turning, and other manipulations so the patient feels sore or numb.
    5. Set the waveform of the electroacupuncture instrument to continuous wave41, frequency to 1.5 Hz, and current intensity to 0.5 mA. (Figure 5).
    6. Perform acupuncture for 30 min at a time five times a week for 4 weeks.
  2. Chinese medicine ironing therapy
    1. Examine the patient's abdominal ironing area for skin integrity without breakage.
    2. Put fennel (300 g) into a disposable sterile cloth bag (20 cm x 30 cm), heat it in a microwave oven for 3 min (temperature 50 to 70 °C), and tie the reyan bag tightly.
    3. Wear sterile gloves, expose the patient's abdominal skin, and apply the reyan bag to Zhongwan (CV12), Shenque (CV8), Tianshu (ST25), and Guanyuan (CV4) (Figure 6).
      1. Press the reyan bag clockwise with the patient's navel as the center.
      2. In the beginning, use a lighter pressure and move it slightly faster. As the temperature of the reyan bag decreases, use a heavier pressure, slower, lasting about 5 min.
      3. When the patient's skin feels warm without burning pain, apply the reyan bag to Zhongwan (CV12) to continue the hot compress (Figure 7). Apply the reyan bag at each acupoint for 5 min. Perform this for 20 min each once daily for 4 weeks of treatment.

4. Statistical analysis

  1. Express the continuous variables as mean ± standard deviation. Use one-way analysis of variance for multi-group comparison and the LSD-t test for pairwise comparison between groups.
  2. Express the categorical variable as cases (percentage) and use the Chi-square test to compare groups. Test level α = 0.05 (two-tailed).

Results

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study screened and included 60 patients with FC from August 2022 to December 2022 who attended the Zigong First People's Hospital. The random number table method was used to divide the patients into the control group, experimental group A (electroacupuncture group), experimental group B (CMIT group), and group C (electroacupuncture + CMIT group), with 15 cases each. There were no statistical differences in gender, age, and disease duration among the four groups (see Table 1).

We conducted CSBMs, CSS, and PAC-QOL questionnaires before and after treatment. Before treatment, CSBMs, CSS, and PAC-QOL scores of all groups showed no statistical difference and were comparable. After 4 weeks of treatment, CSBMs increased, and CSS scores decreased in all groups. The CSBMs, CCS, and PAC-QOL scores of group C were better than the control group, groups A and B (p < 0.05). The PAC-QOL score of group B was better than group A (p < 0.05) (see Table 2). The results suggest that electroacupuncture combined with CMIT can improve the frequency of patients' voluntary bowel movements, constipation, and quality of life. No severe adverse reactions occurred in all groups.

Electrophoresis setup with power supply and reagents, illustrating DNA separation method.
Figure 1: Materials for electroacupuncture. (A) Acupuncture needle. (B) 75% ethanol disinfectant. (C) Medical cotton swab. (D) Electronic needle therapy instrument. Please click here to view a larger version of this figure.

Cumin drying process; cumin seeds, textile sheet, drying paper; experimental setup in drying study.
Figure 2: Materials for Chinese medicine ironing therapy. (A) Fennel. (B) Disposable sterile cloth bag. (C) Disposable sterile gloves. Please click here to view a larger version of this figure.

Acupuncture point LI11 diagram; arm anatomy labeled for educational study.
Figure 3: Quchi (LI11) acupoint position. Locate the acupoint at the middle of the line between the lateral end of the elbow stripe and the humerus's external epicondyle. Please click here to view a larger version of this figure.

Acupuncture point diagram, Dubi (ST35) to Shangjuxu (ST37), showing 6-cun measurement on leg.
Figure 4: Shangjuxu (ST37) acupoint position. Locate the acupoint at the anterolateral side of the lower leg, 6 cun (12 cm38) below the Dubi, with one cross finger (middle finger) from the front edge of the tibia. Please click here to view a larger version of this figure.

Acupuncture points Quchi and Shangjuxu with electrodes in an electroacupuncture setup diagram.
Figure 5: Electroacupuncture of Quchi (LI11) and Shangjuxu (ST37). Please click here to view a larger version of this figure.

Acupuncture points diagram on abdomen with labeled Chinese meridians; traditional medicine study.
Figure 6: Acupoints for abdominal ironing treatment. Zhongwan (CV12) was in the upper abdomen, anterior median line, 4 F-cun above the umbilicus. Shenque (CV8) was in the middle of the umbilicus. Tianshu (ST25) was on the abdomen, in the horizontal umbilicus, 2 F-cun from the anterior median line. Guanyuan (CV4) was in the lower abdomen, midline anterior, and 3 F-cun below the umbilicus. Please click here to view a larger version of this figure.

Abdominal thermotherapy; blue heating pad on stomach for pain relief, therapeutic application.
Figure 7: Leave the reyan bag at Zhongwan (CV12) and continue ironing. Please click here to view a larger version of this figure.

GroupMaleFemaleAgeDisease duration
Control group (n=15)7861.93 ± 5.773.77 ± 1.84
Experimental group A (n = 15)8760.53 ± 5.393.37 ± 1.68
Experimental group B (n = 15)8761.33 ± 4.403.53 ± 1.48
Experimental group C (n = 15)7862.13 ± 4.383.74 ± 1.55
x2&F0.570.3052.093
p0.610.8220.112

Table 1: Characteristics of the patients at baseline.

GroupCSBMsCCS scorePAC-QOL score
Before treatmentAfter treatmentBefore treatmentAfter treatmentBefore treatmentAfter treatment
Control group (n = 15)1.57 ± 0.753.21 ± 0.8024.57 ± 5.0819.64 ± 5.0763.64 ± 3.6155.21 ± 3.66
Experimental group A (n = 15)1.4 ± 0.633.73 ± 0.70a23.4 ± 4.9415.2 ± 5.19a63.2 ± 6.4552.33 ± 4.56
Experimental group B (n = 15)2 ± 0.533.87 ± 0.99a25.13 ± 4.8215.53 ± 4.48a63.6 ± 3.8547.87 ± 4.53ab
Experimental group C (n = 15)1.6 ± 0.914.13 ± 0.91abc24.53 ± 5.1613.87 ± 5.55abc63.73 ± 4.6641.47 ± 5.78abc
F-value1.8552.8920.3163.4291.57220.844
p-value0.1480.0430.8140.0230.207<0.001

Table 2: Comparison of CSBMs, CSS, and PAC-QOL scores. (a, compared to the control group, p< 0.05. b, compared to group A, p < 0.05. c compared to group B, p < 0.05).

Discussion

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

The primary pathophysiological basis of FC is the decrease of intestinal motivity caused by sympathetic nerve tension and parasympathetic nerve excitability42. The pathogenesis of FC may be related to intestinal neurotransmitter dysfunction, oxidative stress index balance disruption, aquaporin expression abnormalities, abnormal changes in serum ions, intestinal flora disorders, colorectal sensory and motor function abnormalities, and psychological effects43. Western medicine treatment of FC is mainly based on various types of laxatives and gastrointestinal mitogenic drugs. Long-term use of these drugs may lead to nausea, vomiting, abdominal pain44, electrolyte disorders45, colonic retinopathy46,47, and increase the economic burden on individuals and society.

Chinese medicine believes that constipation is closely related to the spleen and stomach48. There are various methods of TCM treatment for FC, including acupuncture49,50, tuina therapy51, acupressure52, herbal ironing53, and herbal enema54, which are effective.

FC is among the 43 common diseases the World Health Organization recommends for electroacupuncture treatment55. The efficacy of acupuncture in treating constipation and diarrhea ranks among the top two56and has distinctive advantages. Studies have shown that acupuncture can enhance intestinal motility22, regulate gastrointestinal function, and reduce constipation symptoms57.

Electroacupuncture at Shenque (CV8) acupoint has been proven to improve fecal water content and intestinal transport rate in rats suffering from functional constipation, possibly by the regulation of the aquaporin-3(AQP3) expression and nuclear factor-kappa B(NF-κB) signaling pathways58.

Fennel has been used in traditional medicine for various ailments related to the digestive, endocrine, reproductive, and respiratory systems59. Fennel has many pharmacological effects such as antioxidant, anti-inflammatory, antimicrobial, antithrombotic, hypotensive, gastroprotective, hepatoprotective, memory enhancing, and antimutagenic activities60. The heated reyan bag stimulates the abdominal Zhongwan (CV12), Shenque (CV8), and other acupoints, promoting Qi, removing blood stasis, and clearing collaterals. Abdominal massage along the direction of significant intestine excretion increases the rhythmic contraction of the small and large intestines, speeds up transport, and makes stool soft and easy to discharge61,62.

Acupuncture is an invasive procedure that may involve the risk of fainting needles, sticking needles, bleeding, and wound infection, so it requires an experienced physician to perform the function and promote sterility awareness. In this study, electroacupuncture was used to enhance the acupuncture needle sensation and improve the therapeutic effect on the one hand, to ensure the consistency of acupuncture treatment on the other hand, and to avoid the influence of different operators' performing acupuncture techniques on the trial.

The acupoints selected for this study were Quchi (LI11) and Shangjuxu (ST37), which are the points of recruitment of the large intestine and the end of lower healing, respectively. Both of these points are considered primary acupoints in TCM for treating diseases of the internal organs and are commonly used in patients with FC34. The combination of Quchi (LI11) and Shangjuxu (ST37) belongs to the compatibility of He-sea points, which is used to treat the inner fu-organs. Neijing believes that the effect of the combined points and the lower combined points is the same63. A previous study64 has shown that the compatibility of He-sea points can significantly increase CSBMs, improve the difficulty of defecation and the quality of life of patients, and the combination of points and points can maintain efficacy for 4 weeks after stopping treatment.

The overheated reyan bag will enhance the patient's discomfort and even cause skin burns, so the reyan bag needs to be moved gently and quickly at the beginning of the treatment and then placed on the Zhongwan (CV12) for continuous ironing treatment after the patient gets used to the temperature of reyan bag.

The present study has certain limitations. First, FC is divided into slow transmission, outlet obstruction, and mixed types, which behave differently1. In this study, FC was not typed, and there was a lack of comparison of efficacy indicators related to different types of FC, thus failing to clarify the types of FC that are sensitive to electroacupuncture combined with CMIT. Second, this study was a single-center study with a small sample size, and the heterogeneous effect of comorbidities on treatment effectiveness was not analyzed. Therefore, further trials are needed to investigate the clinical advantages and disadvantages of electroacupuncture combined with CMIT for FC, complement existing treatments, and explore whether electroacupuncture combined with CMIT is the best treatment for FC.

Compared with Western medicine alone, electroacupuncture combined with CMIT can improve the frequency of patients' voluntary bowel movements, constipation, and quality of life.

Disclosures

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

The author has no conflict of interest to disclose.

Acknowledgements

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,

This study was supported by the Key Research and Development Plan (Major Science and Technology Special Project) of the Sichuan Provincial Science and Technology Department (Number: 2022YFS0392) and the Key Discipline Construction Project of the Sichuan Provincial Administration of Traditional Chinese Medicine (Number:202072).

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
75% alcohol disinfectantShandong Anjie Gaoke Disinfection Technology Co. LTDQ/371402AAJ008
Absorbent Cotton SwabZigong Jisheng Medical Equipment Co. LTDChuan machine registration 20162140199
Acupuncture needle (0.25 mm x 50 mm)Suzhou Medical Supplies Factory Co. LTDSu machine registration 20162270970
Disposable sterile cloth bagZigong first People's Hospital material departmentN/A
Disposable sterile glovesKefu Medical Technology Co. LTDXiang machine registration 20202140410
FennelHuazhou Huayi Chinese Medicine slices Co.LTDYue 20160614
G91-A type electronic needle therapy instrument and supporting electrode wireSuzhou Medical Supplies Factory Co. LTDSu machine registration 20172270675
Lactulose oral solutionAbbott Trading (Shanghai) Co. LTDH11022318

References

$$\rightleftharpoonup{xx}$$ $$\longleftharp{xx}$$, $$\longrightharp{xx}$$,
  1. Functional bowel disorders with diarrhea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. 10 (6), 556-584 (2022).">Savarino, E., et al. Functional bowel disorders with diarrhea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. 10 (6), 556-584 (2022).
  2. A practical approach to diagnosis and management of functional constipation in adults. Intern Emerg Med. 8 (4), 275-282 (2013).">Bassotti, G., Villanacci, V. A practical approach to diagnosis and management of functional constipation in adults. Intern Emerg Med. 8 (4), 275-282 (2013).
  3. Recent advances in understanding and managing chronic constipation. F1000Res. 7, F1000 Faculty Rev-1640 (2018).">Prichard, D. O., Bharucha, A. E. Recent advances in understanding and managing chronic constipation. F1000Res. 7, F1000 Faculty Rev-1640 (2018).
  4. Chronic constipation and abdominal pain: Independent or closely interrelated symptoms. J Gastroenterol Hepatol. 35 (8), 1294-1301 (2020).">Wong, M. Y. W., Hebbard, G., Gibson, P. R., Burgell, R. E. Chronic constipation and abdominal pain: Independent or closely interrelated symptoms. J Gastroenterol Hepatol. 35 (8), 1294-1301 (2020).
  5. Prevalence of chronic constipation and its associated factors in Pars cohort study: A study of 9000 adults in Southern Iran. Middle East J Dig Dis. 10 (2), 75-83 (2018).">Moezi, P., et al. Prevalence of chronic constipation and its associated factors in Pars cohort study: A study of 9000 adults in Southern Iran. Middle East J Dig Dis. 10 (2), 75-83 (2018).
  6. Long-term risks of Parkinson's disease, surgery, and colorectal cancer in patients with slow-transit constipation. Clin Gastroenterol Hepatol. 19 (12), 2577-2586 (2021).">Song, E. M., et al. Long-term risks of Parkinson's disease, surgery, and colorectal cancer in patients with slow-transit constipation. Clin Gastroenterol Hepatol. 19 (12), 2577-2586 (2021).
  7. Constipation and risk of death and cardiovascular events. Atherosclerosis. 281, 114-120 (2019).">Sumida, K., et al. Constipation and risk of death and cardiovascular events. Atherosclerosis. 281, 114-120 (2019).
  8. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6 (8), 638-648 (2021).">Barberio, B., Judge, C., Savarino, E. V., Ford, A. C. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6 (8), 638-648 (2021).
  9. Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis. Gut. 66 (9), 1611-1622 (2017).">Nelson, A. D., et al. Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis. Gut. 66 (9), 1611-1622 (2017).
  10. Cost effectiveness of treatments for chronic constipation: A systematic review. Pharmacoeconomics. 36 (4), 435-449 (2018).">Han, D., Iragorri, N., Clement, F., Lorenzetti, D., Spackman, E. Cost effectiveness of treatments for chronic constipation: A systematic review. Pharmacoeconomics. 36 (4), 435-449 (2018).
  11. Controversies in the management of functional constipation in children. Curr Gastroenterol Rep. 21 (6), 23(2019).">van Mill, M. J., Koppen, I. J. N., Benninga, M. A. Controversies in the management of functional constipation in children. Curr Gastroenterol Rep. 21 (6), 23(2019).
  12. Systematic review: the effects of fiber in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 33 (8), 895-901 (2011).">Suares, N. C., Ford, A. C. Systematic review: the effects of fiber in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 33 (8), 895-901 (2011).
  13. Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial. Gut Microbes. 15 (1), 2197837(2023).">Lai, H., et al. Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial. Gut Microbes. 15 (1), 2197837(2023).
  14. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 54 (2), 169-177 (2019).">Gao, R., et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 54 (2), 169-177 (2019).
  15. The effect of Psyllium husk on intestinal microbiota in constipated patients and healthy controls. Int J Mol Sci. 20 (2), 433(2019).">Jalanka, J., et al. The effect of Psyllium husk on intestinal microbiota in constipated patients and healthy controls. Int J Mol Sci. 20 (2), 433(2019).
  16. Comparative efficacy and safety of lactulose plus paraffin vs polyethylene glycol in functional constipation: a randomized clinical study. United European Gastroenterol J. 8 (8), 923-932 (2020).">Piche, T., Dapoigny, M. Comparative efficacy and safety of lactulose plus paraffin vs polyethylene glycol in functional constipation: a randomized clinical study. United European Gastroenterol J. 8 (8), 923-932 (2020).
  17. Topical therapy with rhubarb navel plasters in patients with chronic constipation: Results from a prospective randomized multicenter study. J Ethnopharmacol. 264, 113096(2021).">Wei, L., et al. Topical therapy with rhubarb navel plasters in patients with chronic constipation: Results from a prospective randomized multicenter study. J Ethnopharmacol. 264, 113096(2021).
  18. Efficacy and safety of Prucalopride in chronic constipation: An integrated analysis of six randomized, controlled clinical trials. Dig Dis Sci. 61 (8), 2357-2372 (2016).">Camilleri, M., et al. Efficacy and safety of Prucalopride in chronic constipation: An integrated analysis of six randomized, controlled clinical trials. Dig Dis Sci. 61 (8), 2357-2372 (2016).
  19. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 39 (10), 2960-2969 (2020).">Zhang, C., et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 39 (10), 2960-2969 (2020).
  20. Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilization by patients and healthcare professionals. Proc Nutr Soc. 79 (1), 147-157 (2020).">Dimidi, E., Mark Scott, S., Whelan, K. Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilization by patients and healthcare professionals. Proc Nutr Soc. 79 (1), 147-157 (2020).
  21. Impact of a probiotic product on bowel habits and microbial profile in participants with functional constipation: A randomized controlled trial. J Dig Dis. 20 (9), 435-446 (2019).">Martoni, C. J., Evans, M., Chow, C. T., Chan, L. S., Leyer, G. Impact of a probiotic product on bowel habits and microbial profile in participants with functional constipation: A randomized controlled trial. J Dig Dis. 20 (9), 435-446 (2019).
  22. Acupuncture for chronic severe functional constipation: A randomized trial. Ann Intern Med. 165 (11), 761-769 (2016).">Liu, Z., et al. Acupuncture for chronic severe functional constipation: A randomized trial. Ann Intern Med. 165 (11), 761-769 (2016).
  23. Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews. J Integr Med. 20 (1), 13-25 (2022).">Yao, J. P., et al. Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews. J Integr Med. 20 (1), 13-25 (2022).
  24. Effect of manual acupuncture, electroacupuncture and moxibustion on intestinal motility and expression of enteric nervous activity related proteins in functional constipation rats. Zhen Ci Yan Jiu. 42 (5), 407-412 (2017).">Zhang, X., et al. Effect of manual acupuncture, electroacupuncture and moxibustion on intestinal motility and expression of enteric nervous activity related proteins in functional constipation rats. Zhen Ci Yan Jiu. 42 (5), 407-412 (2017).
  25. The effect and mechanism of electroacupuncture at LI11 and ST37 on constipation in a rat model. Acupunct Med. 34 (3), 194-200 (2016).">Zhu, X., et al. The effect and mechanism of electroacupuncture at LI11 and ST37 on constipation in a rat model. Acupunct Med. 34 (3), 194-200 (2016).
  26. Efficacy and safety of acupuncture at Tianshu (ST25) for functional constipation: Evidence from 10 randomized controlled trials. Evid Based Complement Alternat Med. 2020, 2171587(2020).">Li, P., et al. Efficacy and safety of acupuncture at Tianshu (ST25) for functional constipation: Evidence from 10 randomized controlled trials. Evid Based Complement Alternat Med. 2020, 2171587(2020).
  27. Electroacupuncture for functional constipation: A multicenter, randomized, control trial. Evid Based Complement Alternat Med. 2017, 1428943(2017).">Wu, X., et al. Electroacupuncture for functional constipation: A multicenter, randomized, control trial. Evid Based Complement Alternat Med. 2017, 1428943(2017).
  28. Comparative observation on the curative effect of Chinese medicine ironing and ear point pressing after anal fistula operation. Sichuan Chinese Medicine. 39 (10), 205-208 (2021).">Liu, J., et al. Comparative observation on the curative effect of Chinese medicine ironing and ear point pressing after anal fistula operation. Sichuan Chinese Medicine. 39 (10), 205-208 (2021).
  29. Effect of hot cumin compresses on gastrointestinal function recovery after laparoscopic radical colorectal cancer surgery. Chinese Journal of Modern Medicine. 29 (20), 92-95 (2019).">Qin, C., et al. Effect of hot cumin compresses on gastrointestinal function recovery after laparoscopic radical colorectal cancer surgery. Chinese Journal of Modern Medicine. 29 (20), 92-95 (2019).
  30. Bowel disorders. Gastroenterology. 150 (6), 1393-1407 (2016).">Mearin, F., et al. Bowel disorders. Gastroenterology. 150 (6), 1393-1407 (2016).
  31. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 17 (1), 21-39 (2020).">Vriesman, M. H., Koppen, I. J. N., Camilleri, M., Di Lorenzo, C., Benninga, M. A. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 17 (1), 21-39 (2020).
  32. Consensus opinion on the combined diagnosis and treatment of functional constipation in Chinese and Western medicine (2017). Chinese Journal of Integrative Medicine and Digestion. 26 (01), 18-26 (2018).">Li, J., et al. Consensus opinion on the combined diagnosis and treatment of functional constipation in Chinese and Western medicine (2017). Chinese Journal of Integrative Medicine and Digestion. 26 (01), 18-26 (2018).
  33. Combining Chinese and Western medicine therapy in treating functional constipation in 52 cases is effective. Chinese Journal of Anorectal Diseases. 42 (09), 37-39 (2022).">Lv, Y., et al. Combining Chinese and Western medicine therapy in treating functional constipation in 52 cases is effective. Chinese Journal of Anorectal Diseases. 42 (09), 37-39 (2022).
  34. Efficacy and safety of vibrating capsule for functional constipation (VICONS): A randomized, double-blind, placebo-controlled, multicenter trial. EClinicalMedicine. 47, 101407(2022).">Zhu, J., et al. Efficacy and safety of vibrating capsule for functional constipation (VICONS): A randomized, double-blind, placebo-controlled, multicenter trial. EClinicalMedicine. 47, 101407(2022).
  35. Translation and validation of the traditional Chinese version of the constipation severity instrument. J Chin Med Assoc. 84 (3), 299-302 (2021).">Tsai, Y. J., Yang, Y. W., Lan, Y. T. Translation and validation of the traditional Chinese version of the constipation severity instrument. J Chin Med Assoc. 84 (3), 299-302 (2021).
  36. Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial. Gut Microbes. 9 (3), 236-251 (2018).">Ibarra, A., Latreille-Barbier, M., Donazzolo, Y., Pelletier, X., Ouwehand, A. C. Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial. Gut Microbes. 9 (3), 236-251 (2018).
  37. A randomized controlled study on treating functional constipation by electroacupuncture of the large intestine with acupuncture points under the acupuncture points with matching ends. Sichuan TCM. 36 (04), 185-188 (2018).">Zhong, F., et al. A randomized controlled study on treating functional constipation by electroacupuncture of the large intestine with acupuncture points under the acupuncture points with matching ends. Sichuan TCM. 36 (04), 185-188 (2018).
  38. A comparison between directional and proportional methods in locating acupuncture points using dual-energy X-ray absorptiometry in Korean women. American Journal of Chinese Medicine. 34 (5), 749-757 (2006).">Park, H. J., et al. A comparison between directional and proportional methods in locating acupuncture points using dual-energy X-ray absorptiometry in Korean women. American Journal of Chinese Medicine. 34 (5), 749-757 (2006).
  39. Meridians and Acupoints. , People's Military Medical Press. Singing Dragon, London and Philadelphia. (2010).">Shen, X. Y. Meridians and Acupoints. , People's Military Medical Press. Singing Dragon, London and Philadelphia. (2010).
  40. Accuracy and precision in acupuncture point location: A critical systematic review. Journal of Acupuncture and Meridian Studies. 12 (2), 52-66 (2019).">Godson, D. R., Wardle, J. L. Accuracy and precision in acupuncture point location: A critical systematic review. Journal of Acupuncture and Meridian Studies. 12 (2), 52-66 (2019).
  41. Cupping treatment the clinical effect of the treatment of functional constipation and experimental research. Liaoning University of Chinese Medicine. , (2019).">Zhang, H. Cupping treatment the clinical effect of the treatment of functional constipation and experimental research. Liaoning University of Chinese Medicine. , (2019).
  42. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 396 (10263), 1664-1674 (2020).">Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., Ford, A. C. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 396 (10263), 1664-1674 (2020).
  43. Progress in the study of the mechanism of functional constipation. Chinese Modern Physicians. 61 (04), 121-128 (2023).">An, D. W., et al. Progress in the study of the mechanism of functional constipation. Chinese Modern Physicians. 61 (04), 121-128 (2023).
  44. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterol. 20 (1), 150(2020).">Hao, Z., et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterol. 20 (1), 150(2020).
  45. Assessment of the effectiveness, compliance, and effect on blood electrolytes of polyethylene glycol, mannitol, and magnesium sulfate in bowel preparation before colonoscopy. China Practical Medicine. 14 (30), 88-89 (2019).">Wu, S., et al. Assessment of the effectiveness, compliance, and effect on blood electrolytes of polyethylene glycol, mannitol, and magnesium sulfate in bowel preparation before colonoscopy. China Practical Medicine. 14 (30), 88-89 (2019).
  46. Discovery of a case of pharmacogenetic colonic melanosis and thoughts on pharmacy services. Practical Drugs and Clinics. 26 (03), 237-240 (2023).">Xiao, J. Discovery of a case of pharmacogenetic colonic melanosis and thoughts on pharmacy services. Practical Drugs and Clinics. 26 (03), 237-240 (2023).
  47. Progress of research on the effects and mechanisms of anthraquinone-containing herbal medicines on colonic melanosis. Journal of Tianjin University of Traditional Chinese Medicine. 41 (04), 539-544 (2022).">Zhang, Z., et al. Progress of research on the effects and mechanisms of anthraquinone-containing herbal medicines on colonic melanosis. Journal of Tianjin University of Traditional Chinese Medicine. 41 (04), 539-544 (2022).
  48. Overview of research on the treatment of functional constipation with Chinese medicine specialties. Henan TCM. 43 (01), 146-151 (2023).">Li, G., et al. Overview of research on the treatment of functional constipation with Chinese medicine specialties. Henan TCM. 43 (01), 146-151 (2023).
  49. Clinical study on treating Yang deficiency type chronic functional constipation with warm acupuncture and moxibustion at the Eight Shao points. Journal of Guangzhou University of Traditional Chinese Medicine. 40 (02), 363-367 (2023).">Ma, Q., et al. Clinical study on treating Yang deficiency type chronic functional constipation with warm acupuncture and moxibustion at the Eight Shao points. Journal of Guangzhou University of Traditional Chinese Medicine. 40 (02), 363-367 (2023).
  50. Clinical exploration of acupuncture and moxibustion for treating functional constipation in the elderly based on the five viscera Yuanzhen flux theory. Chinese Journal of Basic Chinese Medicine. 28 (11), 1841-1844 (2022).">Liu, S., et al. Clinical exploration of acupuncture and moxibustion for treating functional constipation in the elderly based on the five viscera Yuanzhen flux theory. Chinese Journal of Basic Chinese Medicine. 28 (11), 1841-1844 (2022).
  51. Current clinical research on treating functional constipation in the elderly with acupressure points. Massage and Rehabilitation Medicine. 13 (24), 44-46 (2022).">Wang, Y., et al. Current clinical research on treating functional constipation in the elderly with acupressure points. Massage and Rehabilitation Medicine. 13 (24), 44-46 (2022).
  52. Clinical observation on treating functional constipation by acupuncture point application of Yi Qi intestine moving cream. Chinese Traditional Chinese Medicine Science and Technology. 29 (05), 834-836 (2022).">Xia, J., et al. Clinical observation on treating functional constipation by acupuncture point application of Yi Qi intestine moving cream. Chinese Traditional Chinese Medicine Science and Technology. 29 (05), 834-836 (2022).
  53. The efficacy of using Ziwu Liujiao herbal hot ironing, abdominal massage, and laxative formula to prevent functional constipation. Clinical Research in Chinese Medicine. 12 (22), 18-21 (2020).">Hu, Y., et al. The efficacy of using Ziwu Liujiao herbal hot ironing, abdominal massage, and laxative formula to prevent functional constipation. Clinical Research in Chinese Medicine. 12 (22), 18-21 (2020).
  54. Effect of Chinese herbal enema combined with acupressure in treating elderly patients with functional constipation. Chinese Journal of Drug Abuse Prevention and Control. 28 (12), 1870-1873 (2022).">Zhang, S., et al. Effect of Chinese herbal enema combined with acupressure in treating elderly patients with functional constipation. Chinese Journal of Drug Abuse Prevention and Control. 28 (12), 1870-1873 (2022).
  55. https://iama.edu/wp-content/uploads/2019/10/acupuncture_WHO_full_report.pdf (2019).">Ebrary, I. Acupuncture: Review and analysis reports on controlled clinical trials. , Available from: https://iama.edu/wp-content/uploads/2019/10/acupuncture_WHO_full_report.pdf (2019).
  56. Study on the spectrum of acupuncture diseases in the digestive system. Clinical Journal of Acupuncture and Moxibustion. 3, 1-2 (2006).">Du, Y., et al. Study on the spectrum of acupuncture diseases in the digestive system. Clinical Journal of Acupuncture and Moxibustion. 3, 1-2 (2006).
  57. Evaluation of the safety and efficacy of acupuncture in treating chronic functional constipation. Liaoning Journal of Traditional Chinese Medicine. 48 (03), 159-162 (2021).">Liu, L., et al. Evaluation of the safety and efficacy of acupuncture in treating chronic functional constipation. Liaoning Journal of Traditional Chinese Medicine. 48 (03), 159-162 (2021).
  58. Exploring the improvement mechanism of gastrointestinal dynamics of functional constipation by electroacupuncture at Shenqui point based on water channel protein 3 and nuclear transcription factor-κB signaling pathway. Journal of Anhui University of Traditional Chinese Medicine. 40 (05), 64-69 (2021).">Xie, L., et al. Exploring the improvement mechanism of gastrointestinal dynamics of functional constipation by electroacupuncture at Shenqui point based on water channel protein 3 and nuclear transcription factor-κB signaling pathway. Journal of Anhui University of Traditional Chinese Medicine. 40 (05), 64-69 (2021).
  59. Foeniculum vulgare Mill: a review of its botany, phytochemistry, pharmacology, contemporary application, and toxicology. Biomed Res Int. 2014, 842674(2014).">Badgujar, S. B., Patel, V. V., Bandivdekar, A. H. Foeniculum vulgare Mill: a review of its botany, phytochemistry, pharmacology, contemporary application, and toxicology. Biomed Res Int. 2014, 842674(2014).
  60. Medicinal properties of Foeniculum vulgare Mill. in traditional Iranian medicine and modern phytotherapy. Chin J Integr Med. 19 (1), 73-79 (2013).">Rahimi, R., Ardekani, M. R. Medicinal properties of Foeniculum vulgare Mill. in traditional Iranian medicine and modern phytotherapy. Chin J Integr Med. 19 (1), 73-79 (2013).
  61. Effect evaluation of Chinese medicine Remai Bao combined with acupoint hot compress nursing intervention in elderly patients with chronic functional constipation. Chronic Epidemiology Magazine. 23 (4), 638-640 (2022).">Li, Y. R. Effect evaluation of Chinese medicine Remai Bao combined with acupoint hot compress nursing intervention in elderly patients with chronic functional constipation. Chronic Epidemiology Magazine. 23 (4), 638-640 (2022).
  62. Observation on nursing effect of Wuren reyan bag pushing and ironing external application on senile constipation. Hunan Journal of Traditional Chinese Medicine. 36 (11), 111-113 (2020).">Wang, Y. Q. Observation on nursing effect of Wuren reyan bag pushing and ironing external application on senile constipation. Hunan Journal of Traditional Chinese Medicine. 36 (11), 111-113 (2020).
  63. Theoretical basis and clinical application of "Hezhi inner government". Jilin Province Traditional Chinese medicine. 5 (01), 81-84 (2017).">Ma, P. H., et al. Theoretical basis and clinical application of "Hezhi inner government". Jilin Province Traditional Chinese medicine. 5 (01), 81-84 (2017).
  64. Comparison of efficacy of different acupuncture points in treating functional constipation: randomized controlled trial. Chinese Journal of Acupuncture and Moxibustion. 34 (06), 521-528 (2014).">Wu, J., et al. Comparison of efficacy of different acupuncture points in treating functional constipation: randomized controlled trial. Chinese Journal of Acupuncture and Moxibustion. 34 (06), 521-528 (2014).

Reprints and Permissions

Request permission to reuse the text or figures of this JoVE article

Request Permission

Tags

Functional ConstipationElectroacupuncture TherapyChinese Medicine IroningGastrointestinal MotilityIntestinal PeristalsisBowel Movement FrequencyAcupuncture PointsPostoperative CareQuality Of LifeGastrointestinal Dynamics
Video Coming Soon

Related Articles